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腹腔镜和开放直肠固定术治疗直肠脱垂后的长期功能结局

Long-term functional outcomes after laparoscopic and open rectopexy for the treatment of rectal prolapse.

作者信息

Byrne Christopher M, Smith Steven R, Solomon Michael J, Young Jane M, Eyers Anthony A, Young Christopher J

机构信息

Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, Australia.

出版信息

Dis Colon Rectum. 2008 Nov;51(11):1597-604. doi: 10.1007/s10350-008-9365-6. Epub 2008 Aug 29.

Abstract

PURPOSE

Laparoscopic rectopexy to treat full-thickness rectal prolapse has proven short-term benefits, but there is little long-term follow-up and functional outcome data available.

METHODS

Patients who had abdominal surgery for prolapse during a ten-year period were identified and interviewed to ascertain details of prolapse recurrence, constipation, incontinence, cosmesis, and satisfaction. Additional details on recurrences that required surgery and mortality were obtained from chart review and the State Death Registry.

RESULTS

Of 321 prolapse operations, laparoscopic rectopexy was performed in 126 patients, open rectopexy in 46, and resection rectopexy in 21 patients. At a median follow-up of five years after laparoscopic rectopexy, there were five (4 percent) confirmed full-thickness recurrences that required surgery. Actuarial recurrence rates of laparoscopic rectopexy were 6.9 percent at five years (95 percent confidence interval, 0.1-13.8 percent) and 10.8 percent at ten years (95 percent confidence interval, 0.9-20.1 percent). Seven patients underwent rubber band ligation for mucosal prolapse and seven required other surgical procedures. There was one recurrence after open rectopexy (2.4 percent) and one after resection rectopexy (4.7 percent), and there was no significant difference between groups. Overall constipation scores were not increased after laparoscopic rectopexy, with no significant difference to open rectopexy or resection rectopexy.

CONCLUSIONS

This study has demonstrated that laparoscopic rectopexy has reliable long-term results for treating rectal prolapse, including low recurrence rates and no overall change in functional outcomes.

摘要

目的

腹腔镜直肠固定术治疗全层直肠脱垂已被证明具有短期益处,但长期随访和功能结局数据很少。

方法

确定在十年期间因脱垂接受腹部手术的患者,并进行访谈以确定脱垂复发、便秘、失禁、美观和满意度的细节。从病历审查和国家死亡登记处获得有关需要手术的复发和死亡率的更多详细信息。

结果

在321例脱垂手术中,126例患者接受了腹腔镜直肠固定术,46例接受了开放直肠固定术,21例接受了切除直肠固定术。腹腔镜直肠固定术后中位随访五年,有5例(4%)确诊为全层复发需要手术。腹腔镜直肠固定术的精算复发率在五年时为6.9%(95%置信区间,0.1-13.8%),在十年时为10.8%(95%置信区间,0.9-20.1%)。7例患者因黏膜脱垂接受了橡皮筋结扎术,7例需要其他手术。开放直肠固定术后有1例复发(2.4%),切除直肠固定术后有1例复发(4.7%),各组之间无显著差异。腹腔镜直肠固定术后总体便秘评分没有增加,与开放直肠固定术或切除直肠固定术无显著差异。

结论

本研究表明,腹腔镜直肠固定术治疗直肠脱垂具有可靠的长期效果,包括低复发率和功能结局无总体变化。

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